Surgical malpractice cases are increasingly citing obstructive sleep apnea (OSA) as a factor in the patient injury, according to a new study.
In the journal Anesthesia & Analgesia, Dennis Auckley, MD, of the MetroHealth Medical Center in Cleveland, OH, and colleagues reviewed three primary databases of legal literature to find cases in which patients with known or suspected OSA had adverse perioperative outcomes between 1991 and 2010. The article was published online ahead of print (doi: 10.1213/ANE.0000000000000841). OSA had to be directly implicated in the outcome, and surgical mishaps such as uncontrolled bleeding were excluded.
The adverse perioperative outcome had to result in a lawsuit that then was adjudicated in a court of law with a final decision rendered. Data were abstracted from each case regarding patient demographics, type of surgery, type and location of adverse event, associated anesthetic and opioid use, and legal outcome. They found 24 cases, most occurring in or after 2007. Most of the operations (92%) were elective, and 71% of the overall group died. The researchers suspect that use of general anesthesia and opioids might have led to complications in 58% and 38% of cases, respectively.
They also found that verdicts favored plaintiffs 58% of the time, with an average award of $2.5 million, ranging from $650,000 to $7.7 million.
Standardized screening tools for OSA should be used more extensively in surgery, the researchers suggest. OSA patients also might need special precautions postoperatively, they say. Some precautions include:
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minimizing opioid use postoperatively;
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trying to keep patients off their backs;
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additional monitoring for patients with known or suspected OSA.
Patients also should be required to bring their at-home therapy, such as a sleep apnea mask, and use it at the hospital postoperatively, they say.
OSA affects about 5% of the population, but most cases are undiagnosed, the researchers note.
“Perioperative complications related to OSA are increasingly being reported as the central contention of malpractice suits. These cases can be associated with severe financial penalties,” the researchers concluded. “These data likely underestimate the actual medicolegal burden, given that most such cases are settled out of court and are not accounted for in the legal literature.” An abstract of the study is available online at http://tinyurl.com/q5rxhqc.
